GENOA HEALTHCARE OF ILLINOIS LLC Pharmacist License verification

Business Entity

CHANGE OF OWNERSHIP

License Type

Pharmacist

Description

LICENSED CONTROLLED PHARMACY SUBSTANCE

License Number

32*****68

License Status

CHANGE OF OWNERSHIP

Business

Business Name

GENOA HEALTHCARE OF ILLINOIS LLC

Original Issue Date

11/17/2010

Effective Date

02/07/2012

Expiration Date

03/31/2014

City

DECATUR

State

Zip

62523

County

MACON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/06/2010